HomeMy WebLinkAbout2017-11-7 - 100 Bidwell Road - Consent to Receive Inspection Reports via Email � dKP
Town of South Windsor — Health Department
" 1540 Sullivan Ave., South Windsor, CT 06074— Mailing Address
s% 1530 Sullivan Ave., South Windsor, CT 06074—Office Address
Phone Number: (860) 337-6173, Fax Number: (860) 644-1930
1 understand that the South Windsor Health Department is now conducting routine inspections
electronically. I elect to receive my inspection report by:
Email CI Fax O USPS Mail
GAa o- F v)SC CcD
Email Address (if applicable)
Fax # (if applicable)
Address
Establishment
Manager/QFO Signature
Manager/QFO Printed
///7'�
Date